To explore how information concerning ICU patients´ families is included in the ICU clinicians’ daily handover.
Handover refers to the transfer of information and care responsibility between clinicians. An effective and precise handover is of great importance to ensure quality of care. Although improvements in handovers have received increasing attention in recent decades, little is known about how information about ICU patients’ family members is included in handovers.
A qualitative study using Charmaz’ constructivist grounded theory approach.
Data were gathered through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. The data consists of 270 observation hours, seven focus groups, three dyadic interviews and two individual interviews. Field notes and transcribed interview data were analysed using constructivist grounded theory approach. COREQ checklist was applied as reporting guideline for this study.
“A game of whispers” emerged as the core category, representing missing information about the patient’s family during the handover. Together with three subcategories: “documentation dilemmas”, “being updated” and “talking together”, the core category explains how transfer of family‐related information between clinicians is continually processed and resolved.
This study indicates challenges related to appropriate and high‐quality handover concerning ICU patients´ families. Oral handovers are essential in terms of clinicians’ need to elaborate on written information and update each other. However, oral transmission involves a high risk of information loss during the handover. Written documentation about the family seems to be inadequate and poorly structured.
The study findings suggest a need for increased awareness in practice and research of the importance of transferring appropriate and reliable information about patients’ families between ICU clinicians. User‐friendly handover tools and patient records that include information on patients’ family members should be developed.
Liver cirrhosis severely decreases patients' quality of life. Since self‐management programs have improved quality of life and reduce hospital admissions in other chronic diseases, they have been suggested to decrease liver cirrhosis burden.
We performed a systematic review and meta‐analysis to evaluate the clinical impact of self‐management programs in patients with liver cirrhosis, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Primary outcomes include health‐related quality of life (HRQOL) and hospitalization. We searched MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO and two trial registers to July 2017.
We identified four randomized trials (299 patients) all rated at a high risk of bias. No difference was demonstrated for HRQOL (Standardized Mean Difference ‐0.01, 95% CI: ‐0.48 to 0.46) and hospitalization days (Incidence Rate Ratio 1.6, 95% CI: 0.5 to 4.8). For secondary outcomes, one study found a statistically significant improvement in patient knowledge (Mean Difference (MD) 3.68, 95% CI: 2.11 to 5.25) while another study found an increase in Model for End‐Stage Liver Disease scores (MD 2.8, 95% CI: 0.6 to 4.9) in the self‐management group. No statistical difference was found for the other secondary outcomes (self‐efficacy, psychological health outcomes, healthcare utilization, mortality). Overall, the quality of the evidence was low. The content of self‐management programs varied across studies with little overlap.
The current literature indicates that there is no evidence of a benefit of self‐management programs for people with cirrhosis.
Practitioners should use self‐management programs with caution when delivering care to patients living with cirrhosis. Further research is required to determine what are the key features in a complex intervention like self‐management. This review offers a preliminary framework for clinicians to develop a new self‐management program with key features of effective self‐management interventions from established models.
Vascular access devices(VAD), centrally CVAD) or peripherally(PIV) located, are common in the nursing profession. A high proportion of admitted patients require a VAD to enable administration of intravenous treatments or diagnostic modalities. As the primary caregivers for these patients, nurses are responsible for ongoing care and maintenance of these devices.
This scoping review examines the current state of practicing nurses knowledge around routine care and maintenance of adult VADs.
In the fall of 2018, the following databases were searched: Medline‐Ovid 1946 to current, Embase‐Ovid 1947 to current, Ebsco CINAHL Plus with full text, and ProQuest Nursing & Allied Health database and articles were selected according to the PRISMA‐ScR checklist. Inclusion criteria: original research published in peer‐reviewed journals; in English or French; focused on practising nurses’ knowledge about the routine care and maintenance of adult VADs.
Of the 4099 abstracts identified, 36 full‐text articles were included. Study characteristics are reported in addition to themes found in the literature: the relationship between demographic data and CVAD/PIV knowledge, the state of nurses’ CVAD/PIV knowledge, and nurses’ CVAD/PIV knowledge scores. Overall, significant gaps in nurses’ knowledge on the care and maintenance of VADs are noted.
The variability in nurses’ knowledge around both CVAD and PIV led the authors to conclude that there is room for improvement in the educational preparation of nurses and a need for workplace training.
This scoping review intends to highlight the knowledge gap of nurses with regards to best practices for VAD routine care and maintenance and demonstrate the need for education, both in educational and healthcare institutions, to ensure high quality care and improved patient outcomes related to VADs.
To describe nurses’ experiences of palliative care for older people with advanced dementia living in residential aged care units.
Dementia is a global health problem and the number of older people with dementia who need palliative care is increasing. Previous research has revealed that care for older people with dementia in the final stage of life is usually complex. However, little is known about how nurses experience palliative care for older people with advanced dementia living in residential aged care units.
Nine individual, semi‐structured face‐to‐face interviews with nurses working in residential aged care units for older people with advanced dementia in palliative care in western Sweden were analysed using qualitative inductive content analysis. The COREQ checklist was followed.
The nurses considered that palliative care for older people with advanced dementia is a complex and challenging form of care. In particular, they identified three challenges that must be met: developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship.
The results of our analysis indicate that if nurses are aware of and understand that the challenges are essential for ‘joining all the pieces together’, the palliative care for older people with advanced dementia may become a positive experience for nurses and may increase their sense of satisfaction and security in their professional role.
For the palliative care to be successful the nurses need to ‘join all the pieces together’, i.e. succeed in developing specialised knowledge and skills, developing teamwork as a working method, and creating a caring relationship to establish a person‐centred care with the older person with advanced dementia and with his or her relatives.
To critically appraise primary research on the views and experiences of parents of children with complex health needs during the transition from hospital to home.
Children with complex health needs frequently transition across and within healthcare systems, due to their age, care needs and ongoing health conditions. Repeated and unplanned admissions are significantly higher for children with complex health needs. Yet parents, as the primary providers of care, report being unsupported and unprepared during the transition from hospital back to home due to poor communication, inadequate discharge planning and education, resulting in stress and anxiety within the home environment.
Systematic review following PRISMA guidelines.
A systematic search was completed of the databases CINAHL, MEDLINE, PsycINFO, EMBASE and the Cochrane Library Review between January 2009 and September 2019. Data were extracted, categorised and analysed using a thematic analysis approach. An adapted CASP qualitative assessment tool was utilised for quality assessment. All included articles were marked for validity and relevance to current research with an overall score from 0–20.
A total of 13 studies of mixed quality were identified. CASP quality scores ranged from 13–18. Four themes emerged highlighting parents' experiences of the emotional processes, communication, coordination and support and resources when transitioning from hospital to home.
Hospital discharge and transition from hospital to home is a complicated and at times frustrating process for parents of children with complex health needs. Parents report being exhausted and stressed during this often‐challenging period of adjustment which was perceived as a difficult and emotional process. There is a clear lack of support available for parents both from hospital and community services.
El objetivo es analizar los resultados del Ranking Cuiden Citación-2019 con las revistas de Enfermería más citadas en Iberoamérica. Se incluyen 51 publicaciones procedentes de seis países (Brasil, Colombia, España, Uruguay, Portugal y Cuba) que han registrado impacto bibliométrico en el último periodo analizado. Se analizan dos indicadores: Repercusión Inmediata Cuiden (RIC) e Índice de Inmediatez. Además se identifican otras revistas de enfermería citadas dentro y fuera del Espacio Científico Iberoamericano (ECI). Destacan las revistas brasileñas, que ocupan las principales posiciones del repertorio, siendo la revista Esc Anna Nery R Enferm la más citada con una RIC de 2,216. El mayor índice de imediatez lo registra la revista Enferm Clínica. Aparecen cinco revistas citadas con posibilidades de incorporarse como revistas fuente en siguientes análisis. Se aprecia un cierto estancamiento en el ritmo de crecimiento de citas en los últimos años, sin que aún podamos hablar de saturación. El número de revistas con repercusión permanece estable, con una ligera tendencia al decrecimiento.
Florence publica este texto en una de las dos entradas que realizó para un diccionario que alcanzó una difusión extraordinaria en su tiempo (se editaron 50.000 ejemplares).1 Es pues un texto claramente divulgativo, orientado a informar a la ciudadanía en general. A pesar de la brevedad del pasaje seleccionado, sintetiza muy bien su pensamiento, condensado en forma de decálogo que recoge los atributos que se asocian al ejercicio enfermero [continuar leyendo en el PDF].
Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation.
This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality.
1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI.
The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
Despite 40 randomised controlled trials (RCTs) investigating preoperative oral antibiotics (OA) and mechanical bowel preparation (MBP) to reduce surgical site infection (SSI) rate following colon surgery, there has never been an RCT published comparing OA alone versus no preparation. Of the four possible regimens (OA alone, MBP alone, OA plus MBP and no preparation), randomised evidence is conflicting for studied groups. Furthermore, guidelines vary, with recommendations for OA alone, OA plus MBP or no preparation. The National Surgical Quality Improvement Program (NSQIP) has automated data collection for surgical patients. Similarly, the ‘REthinking Clinical Trials’ (REaCT) platform increases RCT enrolment by simplifying pragmatic trial design. In this novel RCT protocol, we combine REaCT and NSQIP to compare OA alone versus no preparation for SSI rate reduction in elective colon surgery. To our knowledge, this is the first published RCT protocol that leverages NSQIP for data collection. In our feasibility study, 67 of 74 eligible patients (90%) were enrolled and 63 of 67 (94%) were adherent to protocol. The ‘REaCT–NSQIP’ trial design has great potential to efficiently generate level I evidence for other perioperative interventions.
SSI rates following elective colorectal surgery after preoperative OA or no preparation will be compared. We predict 45% relative rate reduction of SSI, improvement in length of stay, reduced costs and increased quality of life, with similar antibiotic-related complications. Consent, using the ‘integrated consent model’, and randomisation on a mobile device are completed by the surgeon in a single clinical encounter. Data collection for the primary end point is automatic through NSQIP. Analysis of cost per weighted case, cost utility and quality-adjusted life years will be done.
This study is approved by The Ontario Cancer Research Ethics Board. Results will be disseminated in surgical conferences and peer-reviewed journals.
NCT03663504; Pre-results, recruitment phase.
Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.
A meta-analysis of prospective follow-up studies.
Patients with ACS.
We included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline.
We determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS.
Our analysis included 17 studies involving 39 038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p
Anxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients.
As systems of health and social care in England move towards more integrated and collaborative models, leaders will need different skills than their predecessors to enable system leadership, building partnerships and working across organisations and sectors. There is little understanding of what the mechanisms for effective leadership across integrated health and social care systems might be, the contexts that influence good leadership, or the nature of the resulting outcomes. This review aims to identify, refine and test programme theories of leadership of integrated team-based services in health and social care, exploring what works, for whom and in what circumstances.
This study uses a realist synthesis approach, following RAMESES guidelines, supported by stakeholder consultation. Stage 1 will develop initial programme theories about leadership of integrated health and social care based on a review of the scientific and grey literature and a stakeholder consultation workshop. Stage 2 will involve focused searching of empirical literature, data extraction and synthesis to refine the initial programme theories and identify relationships between identified contexts, mechanisms and outcomes. A second stakeholder event will guide the focus of the review. Stage 3 will further refine and interrogate the theories testing them against substantive theory on leadership of complex systems and through the experiences and expertise of the stakeholder group.
Our study does not require ethics committee approval. This research will contribute to building an in-depth understanding of what aspects of leadership of integrated team-based services work, for whom and in what circumstances. It will identify the professional development needs of leaders and provide recommendations about optimal organisational and interorganisational structures and processes that support effective leadership in integrated health and social care systems. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports.
The aim of the study was to describe EMS nurses’ experiences of and coping with critical incidents, when providing nursing care as a member of a dyadic team.
Nursing care in EMS is a complex task, taking into account the physical, psychological as well as existential dimensions of the patient’s suffering. In this, EMS nurses are dependent on the dyadic team. Teams in EMS are described as essential for providing safe medical care. However, nursing care also comprises relationships with patients as a means of reducing patient suffering.
The study has an inductive descriptive qualitative design, in adherence to the COREQ‐checklist.
A critical incident technique was used. Thirty‐five EMS nurses were interviewed individually, with a focus on dyadic teams providing nursing care. The interviews were analysed with the aim of defining main areas, categories and sub‐categories.
The experiences of critical incidents emerged to form two main areas; ‘Functional co‐operation’ and ‘Dysfunctional co‐operation’, comprising seven categories and sixteen sub‐categories. Their coping with critical incidents encompassed two main areas; ‘Adapting oneself’ and ‘Adapting nursing care and the colleague’, comprising four categories and nine sub‐categories.
Reflection as part of the daily practice emerges as important for the development of nursing care both in relation to individual team‐members and also the dyadic team as a unit. In addition, the results highlight consensus within dyadic teams regarding the objectives of nursing care, as well as the importance of defined roles.
This study underlines the importance of strengthening the dyadic EMS team’s ability to co‐operate using common goals and knowledge within clinical nursing care. The individual team members’ different roles have to be explicit. In addition, clinical care has to be organised to generate preconditions for mutual performance monitoring through collegial feedback and reflection.
To develop an understanding of how nurses provide spiritual care to terminally ill patients in order to develop best practice.
Patients approaching the end of life (EoL) can experience suffering physically, emotionally, socially and spiritually. Nurses are responsible for assessing these needs and providing holistic care, yet are given little implementable, evidence‐based guidance regarding spiritual care. Nurses internationally continue to express inadequacy in assessing and addressing the spiritual domain, resulting in spiritual care being neglected or relegated to the pastoral team.
Systematic literature review, following PRISMA guidelines.
Nineteen electronic databases were systematically searched and papers screened. Quality was appraised using the Critical Appraisal Skills Programme qualitative checklist, and deductive thematic analysis, with a priori themes, was conducted.
Eleven studies provided a tripartite understanding of spiritual caregiving within the a priori themes: Nursing Spirit (a spiritual holistic ethos); the Soul of Care (the nurse‐patient relationship) and the Body of Care (nurse care delivery) . Ten of the studies involved palliative care nurses.
Nurses who provide spiritual care operate from an integrated holistic worldview, which develops from personal spirituality, life experience and professional practice of working with the dying. This worldview, when combined with advanced communication skills, shapes a relational way of spiritual caregiving that extends warmth, love and acceptance, thus enabling a patient’s spiritual needs to surface and be resolved.
Quality spiritual caregiving requires time for nurses to develop: the personal, spiritual and professional skills that enable spiritual needs to be identified and redressed; nurse‐patient relationships that allow patients to disclose and co‐process these needs. Supportive work environments underpin such care. Further research is required to define spiritual care across all settings, outside of hospice, and to develop guidance for those involved in EoL care delivery.
To examine the performance of the National Early Warning Score 2 and composite score for clinical worry in identifying patients at risk of clinical deterioration, and to determine relationships between National Early Warning Score 2, clinical worry score, and patient outcome at discharge.
The efficacy of early warning systems depends on patient population and care settings. Based on a theoretical framework on factors affecting clinical deterioration and patient outcomes, studies exploring the relationship between early warning systems and patient outcomes at discharge are sparse.
Retrospective observational study.
A random sample of 732 medical records were reviewed. The area under the receiver‐operating‐characteristic curve was calculated to evaluate predictive abilities regarding the events of unanticipated in‐hospital mortality, unplanned intensive care unit/ higher‐dependency bed admission, and cardiac arrest. Multiple logistic regression analyses were performed to determine relationships between National Early Warning Score 2, clinical worry score, and patient outcome. Reporting followed the STROBE checklist.
National Early Warning Score 2 and clinical worry score significantly predicted the events within 24 hours of the assessment. After controlling for other patient, treatment, and organizational characteristics, National Early Warning Score 2 was a significant factor associated with patient outcome, but clinical worry score was not. Specifically, patients at high risk based on National Early Warning Score 2 were less likely to have improved outcome.
National Early Warning Score 2 and clinical worry score performed well for predicting deteriorating condition of patients. National Early Warning Score 2 was significantly associated with patient outcome. It can be used for efficient patient management for safe, quality care.
National Early Warning Score 2 can be used for early assessment of not only clinical deterioration but also patient outcome and provide timely intervention, when coupled with clinical worry score.